UC training the next generation of war doctors

Mannequins and jet-engine noise are only two of the barriers that doctors, nurses and respiratory therapists confront at the University of Cincinnati's Institute for Military Medicine.

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Members of the Air Force, who are also doctors and nurses, train inside of the C-STARS (Center for Sustainment of Trauma and Readiness Skills) simulation center as a part of the joint program between University of Cincinnati Medical Center and the Air Force offering training for military medical personnel in the areas of trauma and critical care.
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UC's Institute of Military Medicine has $24m partnership with the U.S. Air Force

CORRYVILLE – The soldier on the military cargo plane struggles to breathe. He developed pneumonia while serving in Afghanistan and needs medicine now, but the pump to deliver it won't work properly.

"I can't believe I'm still messing around with this pump," the nurse says, speaking on a headset because the three-person crew is surrounded by the constant roar of the jet engines even as she struggles with the thin air at 30,000 feet.

But those engines aren't real. The "plane" is a simulation center deep inside the University of Cincinnati Medical Center, the pump failure orchestrated from a control room next door. The patient is a mannequin.

The whole thing, in fact, is a training exercise, with those in the control room recording every word and reaction.

"There are communication issues for sure," Air Force Maj. Daniel Cox says after the training exercise is done. "(The doctor) has got to be more vocal."

"The cadre," 17 Air Force trainers housed here at UC, is charged with developing a new generation of war doctors, nurses and respiratory therapists.

UC is one of three training sites for Air Force doctors, including those in the National Guard and Reserves, about to be deployed to Afghanistan or other active theater.

Once deployed, the doctors, nurses and respiratory therapists will treat injured service members being flown to other sites in theater or to an American military hospital in Germany.

Most have backgrounds in critical care, but they often haven't seen the range of injuries common in America's 21st century wars: blast injuries, amputations, multi-trauma head injuries.

"It can be a difficult transition," said Lt. Col. Elena Schlenker, deputy director of the training program, called C-Stars, or Center for Sustainment of Trauma and Readiness Skills.

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Even for doctors and nurses active in the military, the stress, confined space and oxygen-deprived conditions in transport planes can be overwhelming, UC surgery professor Richard Branson said.

The experiments hone in on how altitude affects not only the patients, but the caregivers and their equipment as well.

"There are all kinds of rules for pilots," he said. "How often can they fly? How far can they fly? But there are no rules for the people in the back of the aircraft."

Military medicine big focus of UC research, training center

The training is part of UC's Institute of Military Medicine.

It's one of dozens of centers and institutes at the region's largest university, built around specialties that can lure researchers, produce federal contracts and create revenue.

Air Force training has become a staple there, including a slew of recent contracts that total more than $1 million. Those are extensions of $24 million in contracts signed in 2010, all dealing with air medical evacuation.

UC has a database of more than 5,000 missions flown during the wars in Iraq and Afghanistan and plans to examine treatments and complications.

C-Stars is only one part of the Institute of Military Medicine, with the Air Force paying most of the $4 million-plus the institute collects in research money.

Surgery professor Timothy Pritts, for example, is researching the effects of freezing red blood cells for long transport trips, as well as investigating how to resuscitate patients before transporting them.

Another study involves saline solutions, trying to find the lowest level that can keep an injured soldier alive through the transport.

High altitude of flights affects how treatment works

That all has practical implications – which become even more complicated at high altitudes and under the stress of wartime transport, Branson said.

"This environment also causes gases in a closed space to expand, which can cause the cuff of an endotracheal tube to expand in a patient's airway," he said. "That puts the patients at risk of reduced blood flow and tissue damage."

That's just what the simulator exercise is trying to prevent.

There are 13 two-week sessions per year, each with about 15 students. They do four sessions in the simulation center at UC, and there also are twice-monthly training flights out of Lunken Airport.

As the group in the control room creates problems for the team, they deal with them one by one.

"What we teach is not just maintaining," said Cox, one of the trainers. "We're functioning as an ICU. We expect you to be doing ongoing management so the patient arrives in better condition than when you picked them up."